no title

Editorial

Pay less and get less

Health-care-exchange plans often exclude top cancer centers

About our Editorials

Dispatch editorials express the view of the
Dispatch editorial board, which is made up of the publisher, the president of
The Dispatch, the editor and the editorial-writing staff. As is the traditional newspaper
practice, the editorials are unsigned and intended to be seen as the voice of the newspaper.
Comments and questions should be directed to the
editorial page editor.

The Affordable Care Act promised that people no longer would have to choose between lifesaving
treatments and bankruptcy, but many still could face this choice.

A good number of the nation’s top cancer hospitals, along with the advanced treatments and
access to clinical trials they provide, are off-limits under the new marketplace insurance plans,
the Associated Press reported last week.

Before the Affordable Care Act, insurers could control their costs by denying coverage or
charging more to those with a cancer diagnosis. Now, costs will be contained by putting the best
care out of network and forcing those who want it to pay the higher out-of-network costs.

Of 19 nationally recognized comprehensive cancer centers surveyed by the news service, just four
reported that patients have access through every insurance company participating in their state
exchanges.

For many people, access is spotty. MD Anderson Cancer Center in Houston is an option under just
two of 11 exchange insurers in Texas. Memorial Sloan-Kettering in New York City is included by only
two of 16 exchange insurers in New York.

In Ohio, just three of the 12 insurers in the Ohio’s marketplace exchange include the Ohio State
University Comprehensive Cancer Center — Arthur G. James Cancer Hospital & Richard J. Solove
Research Institute. The cancer center still is talking with other health-exchange carriers.

“There is a marked deterioration of access to the premier cancer centers for people who are
signing up for these plans,” Dan Mendelson, CEO of the market-research firm Avalere Health, told
AP.

Those with money still will have access to the premier care at a comprehensive cancer center.
Meanwhile, the less well-off will go to the general hospitals that insurers are willing to cover in
narrow networks designed to keep premiums low.

Comprehensive cancer centers are more expensive for a good reason: They have multiple missions,
focusing on education and research along with clinical care. Cutting-edge treatments and top
experts don’t come cheap, but they are a bargain if one’s life depends on access to them.

There is another problem: For someone shopping for a policy on the exchanges, it’s not easy to
tell if these top cancer centers are included in the plans offered there. Consumers have to dig to
find out.

While this access problem initially is limited to Affordable Care Act exchanges, it could spill
over to people with employer-provided insurance if company health plans narrow their networks to
offset costs imposed by Obama’s law.

AP notes that leaving cancer centers out of network could become a favored strategy for
insurers: “Insurers can drive away higher-cost cancer patients by not offering this access, driving
patients to other higher-cost plans.”

Bit by bit, Americans are learning that the Affordable Care Act is loaded with unpleasant
surprises. Stuck with an expensive mandate whose promises are fast unraveling, consumers now must
be vigilant when purchasing these plans.

Meanwhile, state regulators should press for clearer disclosure — spelled out in simple language
— so that people understand what lifesaving options they are giving up for their “affordable”
premiums.